Provider Demographics
NPI:1003863408
Name:MCNEIL, JANE S (CRNA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:S
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 KANAWHA BLVD E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-3001
Mailing Address - Country:US
Mailing Address - Phone:304-343-4371
Mailing Address - Fax:304-353-0325
Practice Address - Street 1:1306 KANAWHA BLVD E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-3001
Practice Address - Country:US
Practice Address - Phone:304-343-4371
Practice Address - Fax:304-353-0325
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV035062207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5100591Medicare ID - Type UnspecifiedHOSPITAL GROUP NO